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On the basis of clinical and radiographic examination, ProTaper (Dentsply) that included radiographic working
and the availability of remaining tooth fragment, the length determination (Fig. 5-Working Length
reattachment procedure was planned. Firstly, the Determination), the canal instrumentation up to #F5,
mobile coronal fragment was completely detached from irrigation with 3% sodium hypochlorite, 17% EDTA and
rest of the tooth (Fig. 3-Intra-oral Photograph after normal saline alternatively, complete drying of canal
Detachment of Mobile Coronal Tooth Fragment) and the with paper points and resin sealer (Resinoseal, Amdent
separated tooth fragment has been shown in Fig. 4. Products) application followed by obturation of the root
According to management plan, under local anesthesia, canal with #F5 gutta percha and accessory cones (Fig. 6-
the pulp was extirpated from 21 and the single-visit Obturated Root Canal).
endodontic treatment was performed using manual
At the same visit, post-space preparation of root canal 6 mm of G.P. at apical region) in order to receive a fiber
was done with the help of peeso reamer (leaving around post (Fig. 7-Post Space Preparation of Root Canal). Also,
15 ISSN: 2456-141X
Baranwal AK J. Adv. Res. Dent. Oral Health 2016; 1(1)
the fragmented coronal portion of fractured tooth was Coltene Whaledent) (Fig. 8-Post-operative IOPA
prepared to receive the post passively. Finally, the Radiograph Showing Fiber Post Bonding) following the
detached portion of natural tooth along with the light exact protocol of resin cementation and finished
transmitting fiber post (Tenax, Coletene Whaledent) properly (Fig. 9-Post-operative Intra-oral Photograph
was cemented to the post-endodontically prepared after Complete Reattachment).
central incisor by using dual cure resin (Paracore,
Figure 7.Post Space Preparation of root canal Figure 8.Post-operative IOPA radiograph showing
fiber post bonding
At six-month recall visit, the reattached natural tooth Most vulnerable age for dental injuries is between 6 and
was performing satisfactorily and the radiograph 13 years and among these injuries, most are
demonstrated normal architecture of the surrounding uncomplicated crown fractures, i.e., fracture of enamel
bone. The patient was comfortable with esthetics and and dentin without pulpal exposure and have male
functions. predominancy.1,2,4,5 Many techniques have been
developed to restore the fractured crown and the early
Discussion techniques include stainless steel crowns, basket
crowns, orthodontics bands, pin retained resin,
Trauma to anterior teeth is a very common condition porcelain bonded crown and composite resin.10-12 The
mainly affecting children and adolescents. Dentist must first case of reattaching a fractured incisor fragment was
prepare to treat these patients as it may not only leave reported in 1964 by pediatric dentist at Hebrew
a physical scar but also psychological impact on victim in University, Hadassah School of Dentistry.13
addition to reduction in patient’s quality of life. Most
common site is maxillary anterior teeth especially the Tennery (1978) was first to report the reattachment of a
maxillary central incisors as it occupies most vulnerable fractured fragment using acid-etch technique.14 Several
position in the arch. Usually it involves single tooth but factors influence the management of coronal tooth
accidents and sports injuries can involve multiple tooth fracture including extent of fracture (biological width
injuries. Incidence is one out of every four persons violation, endodontic involvement, alveolus bone
under the age of 18 sustain a traumatic anterior crown fracture), pattern of fracture and restorability of
fracture.1-3 fractured tooth (associated with root fracture),
ISSN: 2456-141X 16
J. Adv. Res. Dent. Oral Health 2016; 1(1) Baranwal AK
17 ISSN: 2456-141X